There is no consensus on the best management of the rectum after subtotal colectomy for refractory colitis complicating inflammatory bowel disease (IBD).The objective was to evaluate the impact of rectal stump management during laparoscopic subtotal colectomy (LSTC) for IBD.
Patients who underwent LSTC with double-end ileo-sigmoidostomy (Gr.A) or end ileostomy with closed rectal stump (Gr.B) for IBD were included from a retrospective database of 6 European referral centres.
314 patients underwent LSTC and were allocated into Gr.A (n=102) and B (n=212). After LSTC, stoma-related complications occurred more frequently in Gr.A (12%) than Gr.B (4%, p=0.01). Completion proctectomy with ileal pouch-anal anastomosis (IPAA) was performed as a 3-stage procedure in all patients from Gr.A, and in 88 patients from Gr.B (42%; Gr.B1). The other 124 patients from Gr.B underwent a modified-2 stage procedure (58%; Gr.B2). The second stage was performed laparoscopically in all patients from Gr.A compared with 73% of Gr.B1 (p<0.0001) and 65% of Gr.B2 patients (p<0.0001). When laparoscopy was intended for 2nd stage IPAA, conversion to laparotomy occurred less frequently in Gr.A when compared with B1 (0 vs 5%, p=0.06) or B2 (10%, p=0.001). When all surgical stages were included (LSCT and IPAA), cumulative stoma-related complications occurred more frequently in Gr.A (n=19) than Gr.B1 (n=6, p=0.02) and Gr.B2 (n=6, p=0.001).
This study suggests that both techniques of double-end ileosigmoidostomy and end ileostomy with closed rectal stump are safe and effective for rectal stump management after laparoscopic subtotal colectomy.

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